Periorbital rejuvenation in composite rhytidectomy

Abstract

Conventional blepharoplasty and rhytidectomy techniques do not adequately address the periorbital area in facial rejuvenation. Conventional blepharoplasty, whether transcutaneous or transconjunctival, normally removes lower-eyelid fat when present and only redrapes the skin from the incision line to the orbital rim. The eyelid frequently appears more hollow after surgery. The diameter of the periorbit does not become youthful, and narrow because the complete orbicularis muscle has not been repositioned. Traditional rhytidectomy techniques redrape facial tissues in a lateral direction toward the ear without repositioning of the orbicularis muscle. Composite rhytidectomy and arcus marginalis release create periorbital rejuvenation by preservation and repositioning of the lower-eyelid fat and repositioning of the orbicularis oculi muscle. This procedure satisfies the goal of harmonious facial rejuvenation by making the lower-eyelid-cheek complex appear as young as the remaining parts of the face that have been surgically rejuvenated. Recent modifications of the arcus marginalis release and the orbicularis repositioning allow more predictable results. These modifications are a zygorbicular (zygorbicular-orbicularis) cheek dissection with an arcus marginalis release and septal reset. A transcanthal canthopexy stabilizes the lateral canthal position. Creation of a firm suborbicularis convex surface with this periorbital rejuvenative technique prevents a hollow lower eyelid and improves the appearance of redraped eyelid skin.